Case Study: Healthcare
Combining rightshoring and design thinking to reduce costs and improve value-based care
Higher CSAT, lower attrition, shorter handle times, and significant savings achieved through Sagility’s operational efficiency expertise
Sagility was with the client at the table during the early stages of the development of this business excellence model. With four decades of extensive expertise and experience, we were able to bring to this program development our healthcare knowledge expertise across commercial and government healthcare segments, as well as our overall extensive experience working across geographies to build and establish standardized processes, uniformity of tools and methodologies, and continual improvement.
Sagility and our partner worked closely to co-create a business excellence framework centered on the mission of globalized service excellence, with a Unified Customer Engagement® across channels and along the lifecycle. Employing Sagility’s design thinking innovation and consultative approach, we provided the cross-training and skillset focus to drive for higher SLAs and a premier, precedent-setting service excellence. We designed a complete revamp of all operational processes—working with the client to analyze those service elements that critically affect service delivery. What were the strengths, weaknesses, and opportunities in hiring? What is the ideal profile for agent fit? What training improvements were needed to optimize CSAT, member retention, and—at the core of it all, agent performance and engagement? Sagility worked closely with our client, sharing our own business excellence expertise, to assess voice of the customer feedback, ask the right questions, and then provide the solution consulting for a program designed to specifically meet excellence objectives. The final program mission was to better advocate for members’ optimal health by helping them get the most from their benefits, building trust, and always providing a clear path to care.
When this project launched, the Pilot Voice Services Team was evenly divided between two locations in Manila, Philippines and comprises one Operations Manager, two Shift Managers, two Team Leads, two Training Managers, two Line Trainers and 20 CSRs. At the heart of our business excellence model are key solution features, to support an agent that advocates striving to help members optimize their benefits.
A more empowered agent with member engagement mindset that incorporates the common purpose in all of their phone calls. This includes better engagement with service improvements such as:
Ultimately, with these premier service excellence features, Sagility has provided customer-centric focused excellence that is transforming this client’s member engagement, for a more B2C market leading approach. Client ROI for this program has been immediate. The Business Excellence Model Team’s performance has been outstanding from day one, with improvements in AHT, FCR, and CSAT. For example, year-to-date quality reached 99.45% in only five months, while Sagility drove CSAT to 96.9%, for a 50% reduction in dissatisfiers. Another critical outcome that showcases the source of the positive outcomes for the client? At the five-month mark, agent attrition is 0%.
The client, impressed with our grasp of operational efficiencies, sought our help in another area of their business: a proof of concept on Medicare Part D. They already trusted our claims management expertise, and they understood firsthand that, with our deep domain knowledge of both commercial and Medicare market segments, we were well versed in the stringent regulations and compliance of government healthcare programs. Ultimately, this client was looking for a more effective process and better use of costly clinical resources as part of their drug labelling and authorization process. Their existing process was burdened with turnaround time (TAT) issues, inconsistent accuracy, and a cumbersome need to source, recruit, and train highly paid clinical resources for a short period during open enrollment each year.
For our PoC, Sagility leveraged our Bangalore and El Paso locations to employ trained (but unlicensed) resources with pharmacy claims knowledge to follow a 24×7 process that decouples initial call triage and fax labelling from the actual clinical authorization process. With our proprietary workflow solution, Sagility handles each provider/member interaction with the appropriate level of trained resource (clinical and non-clinical), thereby making the most cost-effective use of both high-cost clinical and lower-cost non-clinical resources. Sagility has also re-engineered the working hours and locations on a “follow-the-sun” model to ensure adherence to strict regulatory requirements for TAT on all transactions.
In addition to TAT and cost improvements, Sagility’s decoupled approach solves for the critical—and often overlooked—issue of incorrect drug form labeling, which can result in non-compliance with CMS audit, lowered CAHPS rating, and possible federal sanctions.
Sagility’s key role in the Med D drug review and authorization process has included:
With a flexible, decoupled process that provides for optimal process timing and effective resource allocation/utilization, the ROI was immediate for our client and included better turnaround time (25% improvement), significantly improved accuracy and consistency, substantial cost savings (greater than $1 million per year), and reduced need for expensive clinical personnel. Sagility was also able to drive a 60% improvement in call average handle time (AHT) from initial estimates and trigger a mutually successful gain-sharing program. This program was designed to incent the client and Sagility teams to work hand-in glove toward improving the Med D drug approval/denial process.
As a result of the level of success Sagility demonstrated in this PoC, the client chose to transfer all this work from multiple vendors and in-house sites to Sagility, prior to the upcoming open enrollment season. The client has been so impressed with Sagility’s performance that a bid has been extended to adapt this process to the client’s commercial business.
Sagility worked closely with our client, sharing our own business excellence expertise, to assess voice of the customer feedback, ask the right questions, and then provide the solution consulting for a program designed to specifically meet excellence objectives. The final program mission was to better advocate for members’ optimal health by helping them get the most from their benefits, building trust, and always providing a clear path to care.
Sagility launched a Six Sigma project, supported by certified Black Belt professionals, to address a challenging payment integrity audit methodology. The team narrowed the focus to critical lines of business (LOBs) and designed a “Hire Selectively & Train Continuously” program to ensure the workforce delivers consistent efficiency and quality. Training roadmap was revamped to meet the changing process dynamics and calibration sessions were organized to address the analyst and auditor gaps. Boosting KPI’s of low performers through routine feedback & coaching sessions, regular refresher courses and close monitoring via pre- and post-assessment scores had the most visible impact on quality scores. Analysts were tiered and dedicated to performance-guaranteed accounts. Efforts invested in developing a tool to verify overpayment recovery reasons, benchmarking against inaccurate entry or coding errors yielded results. The client’s goal was to achieve 95% accuracy score and Sagility has shown a drastic improvement moving the scores from 85% to 95% within a period of 7 to 8 months. Sagility has been consistently meeting the targets and is the scores are currently hovering over 97%.
“Service providers with both front- and back-office expertise are in a unique position to help clients achieve and exceed their objectives.”
—Russ Uhlmann, Vice President of Client Services, Sagility
Sagility provides strong proof points and ROI at both ends of the lifecycle—member engagement and also the back-office process improvements that can cut turnaround times and improve provider engagement. “Service providers with both front- and back-office expertise are in a unique position to help clients achieve and exceed their objectives,” says Russ Uhlmann, Sagility Vice President of Client Services. “Sagility’s co-creation model and willingness to partner with our clients in proof-of-concept efforts, create both upstream and downstream insights and innovation to truly transform our client’s operations.”
Looking ahead, the client is seeking to build on Sagility’s toolset and unlimited partner approach. There is potential for Sagility to assume more utilization management, clinical intake, and medical necessity responsibilities, in line with the client’s growing population health management focus.
Process de-coupling turnaround time (TAT)
Overpayment recovery 97%quality achieved